April 4, 2014
What's wrong with Toronto hospitals treating patients from Kuwait or Qatar? If it makes the hospitals extra money and doesn't deprive Ontarians of treatment, what's the harm? Given the financial constraints facing the provincial medical system, doesn't it make sense to bring in cash from afar?
It's already happening at Sunnybrook Hospital and Toronto's University Health Network (UHN).
But, in fact, there's a whole lot wrong with so-called medical tourism, and Premier Kathleen Wynne should put the brakes on Health Minister Deb Matthews' enthusiasm for these money-making schemes. Surely Wynne doesn't want to be known as a premier who stood by while public health care was undermined.
If hospitals genuinely need more money to serve Ontarians - the stated goal of their efforts to attract more high-paying patients from abroad - then the government should do a better job of funding health care. The hospitals should not be encouraged to hunt around the world for extra income.
Without government intervention, the drive for international patients will only increase. In the past three years, UHN made $20 million by treating 380 mostly Middle Eastern patients in Toronto. They were either wealthy enough to pay the bills or their governments did so for them.
Expanding such services will only push Ontarians lower on waiting lists for their own necessary treatment. Doctors and nurses attending to pay-for-service foreigners aren't available to help Ontarians. They should be focusing on the patients whose taxes pay for medicare, instead of the time-consuming demands of medical tourists.
As Ontarians watch these wealthy patients jump to the front of the queue, it will lead to other kinds of tension as well. What's to stop rich Ontarians from demanding quick operations if they, too, can pay big bucks? How could hospitals deny wealthy taxpayers the operations they already provide to moneyed foreigners? As Doris Grinspun of the Registered Nurses' Association of Ontario points out, it's a slippery slope that risks further fragmenting a system based on universal care for all.
While hospital CEOs, like the UHN's Bob Bell (soon to be Matthews' deputy minister), say that money earned from international patients provides better care for Ontarians, internal pressure to focus on new medical tourism markets is intense.
The UNH's own strategic plan for 2016 makes that clear. A "CEO Report" dated October, 2013, states the case: "It is ... estimated that the American medical tourism market exceeds $5 B."
While the number of Americans treated would be "limited," the report adds that "including Americans in the UHN's International Patient Program would double program revenues within two years." What business wouldn't want a piece of that? But our hospitals are meant to treat Ontarians, not to develop new business schemes.
The American program, Bell says, is simply a return to the former practice of treating up to 30 paying U.S. citizens a year, which was cancelled roughly eight years ago when malpractice insurance precluded Americans.
It's unfortunate that Matthews isn't fending off this threat to Ontario's health-care system. Instead of allowing hospitals to offer this kind of privatized care, she should follow the example of Quebec's health minister, who called McGill University Health Centre's $200,000 operation on a Kuwaiti woman "unacceptable."
Already, Sunnybrook's plans to treat medical tourists have drawn the ire of such groups as Canadian Doctors for Medicare, which points out that caring for international patients is a huge undertaking that requires expertise and administrative efforts that could otherwise be used for Ontarians. As spokesperson Dr. Ryan Meili says, "We need to have a conversation about the unintended consequences - and there are some big ones."
Rather than cheering their initiative on, health minister Matthews should focus on protecting Ontario's health care system. The people who pay for it deserve better.